Underserved communities and those in rural settings are more likely to have a dermatologic evaluation by a specialist via teledermatology. Addressing important topics such as legal framework and updating reimbursement policies will allow for a smoother incorporation of digital dermatology into clinical practice and likely benefit patient care.Owing to the evolving COVID-19 pandemic and emerging data regarding immunosuppressant therapies for inflammatory cutaneous diseases, dermatologists are being encouraged to reevaluate their patients' treatment regimens to minimize any potential risk of SARS-CoV-2 infection. This article includes an overview of the up-to-date international and U.S. treatment guidelines for psoriasis, atopic dermatitis, hidradenitis suppurativa, and acne/rosacea; it provides tables summarizing these resources to assist providers and patients in remaining updated regarding recommended treatment modifications during the pandemic (See Tables 1-4).Behavioral and psychological symptoms are common in patients with dementia. Especially troublesome are the delusions and hallucinations of dementia-related psychosis (DRP) due to their negative impact on both patients and their carers and family members. This report reviews the impact of DRP on patients and carers, assessment tools, and coping strategies and techniques to help care partners manage DRP.Clinicians now have 2 effective and well-tolerated vesicular monoamine transporter 2 (VMAT2) inhibitors-valbenazine and deutetrabenazine-for the treatment of patients with tardive dyskinesia (TD), a severe and potentially irreversible side effect associated with dopamine receptor blocking agents. Clinicians should use measurement-based care, eg, the Abnormal Involuntary Movement Scale with activation maneuvers, to assess and document TD symptoms and treatment progress. Each follow-up visit should be personalized with questions related to patients' functioning and level of distress regarding their specific TD symptoms. Family members, if available, can provide information on symptom changes and assistance with medication adherence. With continued treatment and measurement-based care, patients can experience improvement in their TD symptoms.Many patients who are at risk for tardive dyskinesia fear that they might develop the involuntary neurological movement disorder, yet it is possible for clinicians to convey a realistic assessment of the benefits and risks of medications that might induce TD. Clinicians need to be aware of the importance of communicating reasonable risk in a way that will not alarm patients, using tools such as probabilities and phronesis in discussions with their patients.While prescription stimulant misuse (PSM) is common in adolescents and young adults (AYAs), PSM motives are poorly understood. This study examined a number of PSM motives across the AYA age spectrum using the 2015-2018 National Survey on Drug Use and Health.
In all, 86,918 AYAs (aged 14-25 years) were included. Individual PSM motives (eg, to study) and motive categories (ie, cognitive enhancement only, recreational only, weight loss only, and combined motives) were examined by age. Logistic regression models examined links between individual motives or motive categories and educational status, substance use, DSM-IV substance use disorders (SUD), and mental health correlates.
Significant differences were found across AYAs in cognitive enhancement only (14 years = 40.4%; 24 and 25 years = 71.2%; P &lt; .0001) and recreational only (14 years = 25.8%; 24 and 25 years = 9.8%; P &lt; .0001) or combined PSM motives, (14 years = 32.3%; 24 and 25 years = 18.0%; P = .008); college students and graduates had parti in AYAs is linked to more substance use, suicidal ideation, and other psychopathology. PSM prevention in adolescents as well as screening and intervention among AYA is highly recommended.The aim of this study was to identify predisposing factors and clinical features at baseline that might help predict diagnosis of bipolar disorder vs schizophrenia in a first-episode psychosis (FEP) cohort.
In this prospective, naturalistic study, we evaluated a cohort of 335 subjects with FEP recruited from April 2009 to April 2012. Baseline features were compared between subjects with a final DSM-IV diagnosis of bipolar disorder and schizophrenia at 12-month follow-up. A binary logistic regression model was used to assess predictors of diagnosis of bipolar disorder at follow-up.
At 12-month follow-up, 47 of the 335 subjects included in the study received the diagnosis of bipolar disorder and 105, of schizophrenia. Subjects with a final diagnosis of bipolar disorder had a higher prevalence of family history of mood disorders (38.2% vs 18.0%, P = .02), better baseline premorbid adjustment (Premorbid Adjustment Scale [PAS] 38.4 vs 50.6, P &lt; .01) and psychosocial functioning (Functional Assessment Shorgative symptoms, and better cognitive flexibility were related to diagnosis of bipolar disorder at 12-month follow-up.Obesity is a leading public health concern. The Centers for Medicare and Medicaid Services implemented a healthcare procedure code for intensive behavioural therapy (IBT) in 2012 to facilitate payment for addressing obesity in primary care settings, followed by universal coverage by insurers for all adults. Our objective was to understand utilization of IBT from 2009 to 2017 in patients with a diabetes diagnosis. Leveraging electronic health record data from the PaTH Clinical Data Research Network (CDRN), a partnership of six health systems, utilization of IBT was summarized at a yearly basis. https://www.selleckchem.com/products/crenolanib-cp-868596.html The trend of IBT prevalence was examined for patients with diabetes by gender, race, age (&gt;=65 vs less then 65) and rurality. A total of 205, 913 patients were included. While utilization of IBT is low (0.24% in 2017), use of IBT increased among patients with commercial insurance and Medicaid (codes S9449 and S9470) in 2011, and among patients with Medicare (code G0447) in 2012. IBT users tended to be less than 65?years of age, female, non-White (Black or Hispanic), and reside in urban areas. Overall, use of IBT in patients with diabetes remains low. Future work is necessary to understand the impact of IBT and, if effective, how to increase use within primary care.